Background and Importance Antibiotic stewardship programme (ASP) consists of a multidisciplinary group involving infectious diseases physicians, microbiologists and pharmacists. ASP improves clinical outcomes, patient safety and help to combat antibiotic resistance. In our hospital, ASP includes daily review of antifungal and broad-spectrum antibiotic prescriptions (AP) in order to optimise the management among hospitalised patients.
Aim and Objectives To assess the appropriateness of antifungal and broad-spectrum AP and the acceptance of interventions made to optimise the antimicrobial management during one year.
Material and Methods Retrospective and observational study of interventions made as a part of the ASP in a multidisciplinary meeting from May 2021 to May 2022. Antifungal (caspofungina, anidulafungin, liposomal amphotericin and triazoles), last treatment choice and broad-spectrum antibiotics prescribed for 2 days were analysed (attending specially to meropenem, ceftazidime-avibactam and ceftolozane-tazobactam). We examined the indication of the AP, if it was an empirical, prophylactic or targeted treatment and the appropriateness. It was considered as inappropiate if an intervention of ASP was needed. Then we made a recommendation according to dosage optimisation, duration of treatment, antibiotic de-escalation and escalation, and necessity for supplementary tests. Finally, interventions acceptance was checked.
Results We analysed 1552 AP. 120, 7.7% were stopped before analysing their appropriateness. Meropenem was the antimicrobial most commonly reviewed (906; 58.4%), followed by caspofungina (74; 4.8%), linezolid (65; 4.2%) and daptomycin (59; 4.8%). Indications for AP were: intraabdominal infections (565; 39.4%), lower respiratory tract infections (269; 18.8%), urinary tract infections (161; 11.2%), bacteremias (83; 5.8%), skin and soft tissue infections (75; 5.2%), febrile neutropenias (66; 4.6%), and less frequently endocarditis and osteoarticular or central nervous system infections.
AP reviewed were: empirical (1020; 71.2%), targeted (377; 26.3%) and prophylactics (36; 2,5%).
Overall, 413, 28.8% of AP were judged inappropriate, 1019, 71.1% appropriate. Regarding unsuitable prescriptions, ASP recommended to: de-escalate (53%), suspend (25,4%), optimise the dose (9,2%), request supplementary test (4,3%) and change the antibiotic (2,4%).
Regarding acceptance of inappropriate AP, 300 (72,6%) interventions were accepted.
Conclusion and Relevance It’s essential to stress the importance in optimising the use of antibiotics with other strategies such as infection control, guidelines development and other activities promoted by an ASP to prevent the spread and emergence of antibiotic resistance.
Conflict of Interest No conflict of interest
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